纳布啡复合丙泊酚麻醉对小儿腺样体切除术后躁动和血流动力学的影响  

Effect of nalbuphine combined with propofol anesthesia on agitation and hemodynamics after adenoidectomy in children

作　　者：陈新伟 刘泽金 王敏燕 朱智瑞[1] CHEN Xin-wei;LIU Ze-jin;WANG Min-yan;ZHU Zhi-rui(Department of Anesthesiology,the Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属儿童医院麻醉科,浙江杭州310000

出　　处：《川北医学院学报》2023年第3期403-406,共4页Journal of North Sichuan Medical College

基　　金：浙江医药卫生科技项目(2017KY443)。

摘　　要：目的:探讨纳布啡复合丙泊酚麻醉对小儿腺样体切除术后躁动和血流动力学的影响。方法:根据术中麻醉方式不同,将128例行腺样体切除术的患儿分为对照组(n=64)和纳布啡组(n=64)。对照组予以舒芬太尼0.2μg/kg复合丙泊酚2~3 mg/kg麻醉;纳布啡组予以纳布啡0.2 mg/kg复合丙泊酚2~3 mg/kg麻醉。比较两组:(1)麻醉诱导开始前(T0)、插管即刻(T1)、手术结束时(T2)及拔管5 min后(T3)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))等水平;(2)两组气管拔管时间、PACU停留时间和拔管后镇静-躁动评分(SAS)、儿童疼痛行为量表(FLACC)评分;(3)两组术后躁动等不良反应发生情况。结果:T0~T3时,两组HR、MAP组间对比,无统计学差异(P>0.05),但相比T0,两组T1时HR、MAP均下降(P<0.05);两组T1时SpO_(2)相比T0均下降(P<0.05),但纳布啡组高于对照组(P<0.05)。相比对照组,纳布啡组气管拔管提前(P<0.05),PACU停留时间缩短(P<0.05),拔管后SAS、FLACC降低(P<0.05)。纳布啡组术后躁动发生率为6.25%,低于对照组的18.75%(P<0.05)。结论:纳布啡复合丙泊酚麻醉用于小儿腺样体切除术,对患儿呼吸影响小,术后苏醒快,且躁动发生率较低。Objective:To investigate the effect of nalbuphine combined with propofol anesthesia on agitation and hemodynamics after adenoidectomy in children.Methods:A total of 128 children undergoing adenoidectomy were divided into control group(n=64)and nalbuphine group(n=64)according to different anesthesia methods.The control group was anesthetized with 0.2μg/kg sufentanil combined with 2~3 mg/kg propofol,and the nalbuphine group was anesthetized with 0.2 mg/kg nalbuphine combined with 2~3 mg/kg propofol.The heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2))and other levels were recorded before anesthesia induction(T0),immediately after intubation(T1),at the end of surgery(T2),and 5 min after extubation(T3)in the two groups.The tracheal extubation time,PACU residence time,sedation-anxiety score(SAS)after extubation,and Face Legs Activity Cry Consol-ability(FLACC)scores were recorded in the two groups.Record two groups of postoperative agitation and other adverse reactions.Results:There was no significant difference in HR and MAP between the two groups at T0~T3(P>0.05),but compared with T0,HR and MAP decreased at T1(P<0.05).SpO_(2)at T1 was lower than that at T0 in both groups(P<0.05),but SpO_(2)in nalbuphine group was higher than that in control group(P<0.05).Compared with the control group,the extubation of nalbuphine group was earlier(P<0.05),PACU residence time was shortened(P<0.05),SAS and FLACC were decreased after extubation(P<0.05).The incidence of postoperative agitation in the nalbuphine group was 6.25%,which was lower than 18.75%in the control group(P<0.05).Conclusion:Nalbuphine combined with propofol anesthesia for adenoidectomy in children has little effect on respiration,rapid recovery and low incidence of agitation.

关 键 词：小儿腺样体切除术 纳布啡 丙泊酚 血流动力学 躁动 

分 类 号：R614.2[医药卫生—麻醉学]